Epigenetic mechanisms were shown to be involved in the control of endocrine cell fate decision, islet differentiation, β-cell identity, proliferation, and mature function. The pathologic mechanisms involved in the development of type 1 diabetes may include DNA methylation, histone modification, microRNA, and molecular mimicry. These mechanisms may act through the regulation of gene expression.

Background Fibroblast growth factor 23 (FGF23), a novel bone-derived hormone that inhibits phosphate reabsorption and calcitriol production by the kidney, has uncovered primary regulatory pathways and new systems biology governing bone mineralization, vitamin D metabolism, parathyroid gland function, and renal phosphate handling.
Aim of the work The aim of the present prospective study was to investigate FGF23 levels in patients with end-stage renal disease before and after a successful renal transplant and their probable association with the markers of bone and mineral metabolism.
Patients and methods A total of 40 patients were studied for 6 months and divided into two groups (hemodialysis vs. renal transplant patients). Serum FGF23, calcium, phosphorus, and intact parathyroid hormone (iPTH) were estimated for both groups. We compared the changes in serum FGF23, calcium, phosphorus, and iPTH in renal transplant patients 3 and 6 months after successful renal transplantation.
Results The serum FGF23 decreased significantly after renal transplantation. iPTH and P levels also decreased significantly after renal transplant, whereas Ca level increased.
Conclusion FGF23 levels were markedly increased in patients with end-stage renal disease associated with an increase in phosphorous and iPTH levels. FGF23 levels decrease dramatically after successful renal transplantation and remain within the normal limits when graft function is good. iPTH and P levels also decrease significantly after renal transplantation, whereas Ca increases.

Background Acute kidney injury (AKI) has consistently been associated with adverse clinical outcome after acute myocardial infarction (MI). In addition, AKI is well-known as a potent predictor of the clinical course in heart failure patients. The aim of this study was to assess the prevalence and risk factors of AKI in patients with acute MI and congestive heart failure (CHF) in the ICU at Zagazig University Hospitals, Egypt.
Patients and methods This study included 100 patients with acute MI and 100 patients with CHF admitted to the ICU. They were subjected to careful history taking, thorough clinical examination, ECG and echocardiographic evaluation, and laboratory investigations, including cardiac enzyme evaluation, renal profile, and fasting blood glucose. Definitions of AKI depend on the measurement of serum creatinine as a surrogate marker for the glomerular filtration rate, in addition to the calculation of estimated glomerular filtration rate.
Results The proportion of patients who experienced AKI was 47% in patients with CHF and 45% in patients with acute MI. They were significantly older in age (P=0.013 and 0.004, respectively). In CHF, patients with AKI had significantly higher fasting blood sugar (P=0.011), abnormal ECG changes (P=0.001), lower ejection fraction (P=0.034), and lower diastolic dysfunction (P=0.027). However, in acute MI, patients with AKI had significantly higher fasting blood sugar (P=0.013) and higher troponin I level (P=0.015).
Conclusion The most important risk factors for AKI in patients with CHF are older age, higher frequency of diabetes mellitus, abnormal ECG changes, lower ejection fraction, and diastolic dysfunction. However, high troponin I and older age are the most important risk factors for AKI in patients with acute MI. Careful monitoring of susceptible patients in the ICU is recommended for early detection and management of AKI in those patients.

Introduction Candida is the most common fungi causing diarrhea. As pathogenesis and susceptibility to antifungals might vary in different species of Candida, their speciation is essential.
Objective The aim of this study was to identify different species of Candida and investigate their antifungal susceptibility pattern.
Materials and methods Of 2036 diarrheal stool samples, 212 samples were microscopically positive for budding yeast cells. We selected 50 of these samples and cultured on blood agar and MacConkey agar and incubated at 37°C for 18–24 h. Tiny colonies confirmed by means of Gram staining as budding yeast cells were subcultured on Sabouraud’s dextrose agar. Speciation of Candida was carried out using the germ tube test and inoculation into chrome agar and corn meal agar. Antifungal susceptibility testing was carried out as per CLSI guidelines using voriconazole, fluconazole, itraconazole, and amphotericin B.
ResultsCandida was mostly isolated from children younger than 12 years (50%) and from male patients. A total of 64 isolates were obtained. Candida krusei (52%) was the most common isolate, followed by Candida tropicalis (16%), Candida albicans (0.02%), and Candida parapsilosis (0.01%). The isolates were mostly susceptible to voriconazole (97.4%), itraconazole (79.4%), amphotericin B (66.6%), and fluconazole (18%).
ConclusionCandida diarrhea was mostly seen in individuals younger than 12 years, most commonly caused by C. krusei. Resistance to fluconazole was high. A rising resistance to amphotericin B is alarming. Speciation of Candida is important to see the difference in antifungal susceptibility in different species.

Introduction Atherosclerotic coronary artery disease is considered to be the most common cause of myocardial ischemia. YKL-40, a chitin-binding acute phase glycoprotein, has been found to be expressed by macrophages in atherosclerotic plaques. The YKL-40 could potentially be a new useful biomarker to monitor severity and predict early diagnosis of acute coronary syndrome (ACS) in ischemic heart disease (IHD) patients.
Aim The aim of this study was to measure the level of serum YKL-40 in IHD patients and to clarify its role as a potentially beneficial diagnostic marker in those patients.
Patients and methods Serum YKL-40 was measured in 60 IHD patients and 30 healthy controls. According to chest pain analysis, ECG changes, and cardiac enzymes, the IHD patients were categorized into patients with stable angina and patients with ACS.
Results The median level of YKL-40 (pg/ml) was significantly elevated in patients with IHD compared with the control group (2080 (575.5–5974.6) vs 522.6 (133.2–769.5), respectively; P<0.001). The median level of YKL-40 was also significantly higher in patients with ACS compared with patients with stable angina (2436 (576–5975) vs 1015 (675–1822), respectively; P˂0.001). There was a positive correlation between YKL-40 levels and high-sensitivity C-reactive protein (mg/dl) in all studied groups of IHD patients. However, no significant correlation was detected between YKL-40 and age, systolic or diastolic blood pressure, and lipid profile in patients with IHD.
Conclusion YKL-40 might play an important role as a diagnostic and prognostic marker in patients with IHD and in patients with ACS.

Introduction and aim Fatigue is one of the most common and prominent symptoms in liver cirrhosis and was reported in 60–80% of these patients. The study outcome was to prospectively evaluate the etiology and the degree of fatigue and how to improve it in chronic liver disease patients.
Patients and methods A prospective cross-sectional study on fatigue in chronic liver diseases was conducted on 500 patients: 475 patients had hepatitis C virus (HCV) and 25 had combined HCV and hepatitis B virus. They were divided into five groups: group 1 included 100 patients with chronic hepatitis, group 2 included 100 patients with Child class A cirrhosis, group 3 included 100 patients with Child class B cirrhosis, group 4 included 100 patients with Child class C cirrhosis, and group 5 included 100 patients with hepatocellular carcinoma (HCC). They were administered the Fatigue Impact Scale and the Fatigue Severity Scale questionnaires (translated into Arabic) as well as subjected to laboratory investigations, abdominal ultrasonography, and upper endoscopy.
Results All (100%) patients complained of longstanding fatigue. HCC had the highest prevalence of high fatigue (65%) and Child class C cirrhosis had the longest fatigue duration. Female sex and anemia were significantly related to both the Fatigue Impact Scale and the Fatigue Severity Scale in each group separately and all patients collectively. Age had a significant relation with all patients collectively but not separately. Fatigue scores were related to Child score but not related to liver profile, α-fetoprotein, varices, ascites, and HCV load.
Conclusion Correction of anemia, not liver profile, helps in alleviating fatigue in cirrhotic patients. Female patients suffered from fatigue more frequently compared with male patients. HCC patients had highest fatigue and patients with Child class C cirrhosis had longest fatigue indices.

A 16-year-old girl presented with swelling and heaviness on the right side of her chest and progressive dyspnoea since 20 days. Radiological examination revealed a mass lesion in the right lower zone with right-sided massive pleural effusion and rib erosion. Histopathology and immunohistochemistry were suggestive of Ewing’s sarcoma. We reported this case because of the uncommon presentation of this rare tumour and its associated pleural effusion. Early diagnosis of this case led to favourable outcomes.